| NPI | 1376501825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 204639) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: RI 09698) |
| 207N00000X Dermatology (Licence: NH 24501) | |
| 207N00000X Dermatology (Licence: FL ME32699) | |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2024-03-06 |